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PubMedDate not supplied

Disaster management following the Chi-Chi earthquake in Taiwan.

The earthquake that occurred in Taiwan on 21 September 1999 killed >2,000 people and severely injured many survivors. Despite the large scale and sizeable impact of the event, a complete overview of its consequences and the causes of the inadequate rescue and treatment efforts is limited in the literature. This review examines the way different groups coped with the tragedy and points out the major mistakes made during the process. The effectiveness of Taiwan's emergency preparedness and disaster response system after the earthquake was analyzed. Problems encountered included: (1) an ineffective command center; (2) poor communication; (3) lack of cooperation between the civil government and the military; (4) delayed prehospital care; (5) overloading of hospitals beyond capacity; (6) inadequate staffing; and (7) mismanaged public health measures. The Taiwan Chi-Chi Earthquake experience demonstrates that precise disaster planning, the establishment of one designated central command, improved cooperation between central and local authorities, modern rescue equipment used by trained disaster specialists, rapid prehospital care, and medical personnel availability, as well earthquake-resistant buildings and infrastructure, are all necessary in order to improve disaster responses.

Disaster Planning↗
PubMed2006

The pediatrician and disaster preparedness.

Recent natural disasters and events of terrorism and war have heightened society's recognition of the need for emergency preparedness. In addition to the unique pediatric issues involved in general emergency preparedness, several additional issues related to terrorism preparedness must be considered, including the unique vulnerabilities of children to various agents as well as the limited availability of age- and weight-appropriate antidotes and treatments. Although children may respond more rapidly to therapeutic intervention, they are at the same time more susceptible to various agents and conditions and more likely to deteriorate if not monitored carefully. The challenge of dealing with the threat of terrorism, natural disasters, and public health emergencies in the United States is daunting not only for disaster planners but also for our medical system and health professionals of all types, including pediatricians. As part of the network of health responders, pediatricians need to be able to answer concerns of patients and families, recognize signs of possible exposure to a weapon of terror, understand first-line response to such attacks, and sufficiently participate in disaster planning to ensure that the unique needs of children are addressed satisfactorily in the overall process. Pediatricians play a central role in disaster and terrorism preparedness with families, children, and their communities. This applies not only to the general pediatrician but also to the pediatric medical subspecialist and pediatric surgical specialist. Families view pediatricians as their expert resource, and most of them expect the pediatrician to be knowledgeable in areas of concern. Providing expert guidance entails educating families in anticipation of events and responding to questions during and after actual events. It is essential that pediatricians educate themselves regarding these issues of emergency preparedness. For pediatricians, some information is currently available on virtually all of these issues in recently produced printed materials, at special conferences, in broadcasts of various types, and on the Internet. However, selecting appropriate, accurate sources of information and determining how much information is sufficient remain difficult challenges. Similarly, guidance is needed with respect to developing relevant curricula for medical students and postdoctoral clinical trainees.

Child↗
PubMed1994

Military participation in emergency humanitarian assistance.

Military forces of the United States and other countries possess training, equipment and capabilities that are suited for work in disaster preparedness and assistance. Information on the use of military units in domestic and foreign disaster-related efforts, particularly by United States forces in the medical area, was obtained by review of the literature and unpublished military reports, and from interviews with people who have been involved with disaster-related activities. The historical reasons for viewing United States forces as resources in disaster situations are identified. Additionally, issues and problems related to disaster preparedness and assistance in general, and more specifically, to the past and future use of military personnel for this mission are examined. The need for a defined military mission for emergency humanitarian assistance and the need for a military organizational structure to support this mission are identified. Once these two critical issues have been properly addressed, the United States military should participate in the establishment of a disaster institute for joint civilian-military disaster planning and training, in both domestic and foreign areas.

Disaster Planning↗
PubMed1994

Special report. From alert to twisters: planning for and coping with tornadoes.

Hospitals in the South put their tornado disaster plans into effect in March when a series of twisters swept through Alabama, Georgia, Tennessee, North Carolina, and South Carolina--destroying homes, killing 43 persons, and injuring another 250. In Piedmont, AL, a town of 5,000, 20 people were killed when a tornado destroyed the Goshen United Methodist Church. In Guntersville, AL, the roof was blown off the Marshall Manor Nursing Home, sending a number of persons to area hospitals. In this report, we will review some of the measures taken by a number of hospitals that received patients and give details on how they prepare to deal with such disasters.

Alabama↗
PubMed2002

Hospitals asked to review disaster packs.

As the nation somberly marked the six-month anniversary of the terrorist attacks on New York and Washington, a group of materials managers and vendors finished drafting a supply list to be used by hospitals in conjunction with a disaster readiness plan.

Disaster Planning↗
PubMed1999

Hurricane Georges and New Orleans hospitals: preparing for a killer storm--Part I.

Last year, the city of New Orleans, LA, was spared what could have been one of the greatest tragedies to ever befall a major American city. In September, Hurricane Georges, which had caused hundreds of deaths and massive destruction in the Caribbean, was heading straight toward New Orleans. The vicious storm had the strength to potentially submerge the low-lying city, protected only by levees. Although New Orleans escaped serious damage when Georges veered off at the last moment, the threat posed by the hurricane resulted in a massive evacuation. More than 1.5 million people were ordered or urged to vacate the city and coastal Louisiana, though not all complied. About 10,000 people took shelter in the Superdome, home of the New Orleans Saints, while thousands more filled other designated shelters in the city. At local hospitals, people took refuge in offices, waiting rooms, conference rooms, hallways, and any other space available. In this report, we'll give details on how six hospitals and health facilities prepared to meet the hurricane, how they fared during the emergency, and how their disaster plans worked. Three of them are covered in this month's issue.

Bed Occupancy↗
PubMed2002

Logistical considerations for emergency response resources.

Resource management is a critical component of disaster preparedness and response. The type and quantity of resources and supplies needed by any particular community will be determined by several factors including the disasters affecting the community, existing resources within the community, resources available from neighboring communities, and the vulnerability assessment of a community. Ideally only needed resources should be requested and delivered. Unsolicited aid can often hamper an emergency response. The needs of a community will change during a disaster. Often the immediate need focuses on the medical sector. Issues such as hygiene, water and shelter will occur later. Disaster planning and logistical management of resources should not only consider the short-term needs of the community but also the long-term consequences of a disaster on the community.

Communication↗
PubMed1988

Impact of urban disaster on a university trauma center.

On the eve of the 1984 Summer Olympics, a deranged man drove his car at high speed onto a pedestriancrowded sidewalk in a suburb of Los Angeles. The UCLA Medical Center, located two blocks from the scene, received 17 of 51 casualties. One patient arrived in full cardiac arrest and could not be resuscitated. Six had minor injuries or temporary hysteria and did not require admission to hospital. The mean injury severity score of the 10 patients who were admitted was 13.6 (range 3 to 48). Three patients required immediate surgical procedures, and two had delayed orthopedic operations. Specialty consultations were needed in orthopedics, neurosurgery, plastic surgery, otolaryngology, pediatric surgery, and pediatric intensive care. There were no subsequent deaths, although two patients had substantial residual neurologic disability. This episode of unexpected urban violence underscores the need for dedicated trauma services in university centers. Functions of such services include disaster planning, deploying surgical personnel, managing injured patients, and analyzing outcomes.

Academic Medical Centers↗
PubMed2005

Rapid health response, assessment, and surveillance after a tsunami--Thailand, 2004-2005.

On December 26, 2004, an earthquake triggered a devastating tsunami that caused an estimated 225,000 deaths in eight countries (India, Indonesia, Malaysia, Maldives, Seychelles, Somalia, Sri Lanka, and Thailand) on two continents. In Thailand, six provinces (Krabi, Phang-Nga, Phuket, Ranong, Satun, and Trang) were impacted, including prominent international tourist destinations. The Thai Ministry of Public Health (MOPH) responded with rapid mobilization of local and nonlocal clinicians, public health practitioners, and medical supplies; assessment of health-care needs; identification of the dead, injured, and missing; and active surveillance of syndromic illness. The MOPH response was augmented by technical assistance from the Thai MOPH-U.S. CDC Collaboration (TUC) and the Armed Forces Research Institute of Medical Sciences (AFRIMS), with support from the office of the World Health Organization (WHO) representative to Thailand. This report summarizes these activities. The experiences in Thailand underscore the value of written and rehearsed disaster plans, capacity for rapid mobilization, local coordination of relief activities, and active public health surveillance.

Disaster Planning↗
PubMed1993

Disaster assessment: the emergency health evaluation of a population affected by a disaster.

In the past decade, interest in the operational and epidemiologic aspects of disaster medicine has grown dramatically. State, local, and federal organizations have created vast emergency response networks capable of responding to disasters, while hospitals have developed extensive disaster plans to address mass casualty situations. Increasingly, the US armed forces have used both their ability to mobilize quickly and their medical expertise to provide humanitarian assistance rapidly during natural and man-made disasters. However, the critical component of any disaster response is the early conduct of a proper assessment to identify urgent needs and to determine relief priorities for an affected population. Unfortunately, because this component of disaster management has not kept pace with other developments in emergency response and technology, relief efforts often are inappropriate, delayed, or ineffective, thus contributing to increased morbidity and mortality. Therefore, improvements in disaster assessment remain the most pressing need in the field of disaster medicine.

Disaster Planning↗
PubMed1995

The day the earth moved.

Diane Lowder wasn't sure how ready her hospital was for a catastrophe. But a unique disaster plan helped keep Northridge Hospital open after the '94 Los Angeles earthquake. Here's what Lowder saw at the epicenter.

California↗
PubMed2005

Falling towers, crumbling levees, and viral mutations.

Hurricanes Katrina and Rita destroyed an entire beloved city and shattered a large part of the US Gulf Coast. Unlike the destruction of 9/11, it is difficult to say at the time of this writing whether or not this region will ever be fully restored. In light of these and other man-made and natural disasters, the world needs to revisit its approach to disaster planning and preparedness to insure that we can best meet the needs of those likely to be affected by future calamities.

Disaster Planning↗
PubMed1991

Emergency preparedness: the best defense for major disasters.

This article discusses how Silver Cross Hospital in Joliet, Illinois developed its disaster plan and how that plan was successfully tested when a tornado plowed through its service area, causing mass casualties who required both inpatient and outpatient care.

Disaster Planning↗
PubMedDate not supplied

Accident and disaster epidemiology.

Natural disasters such as floods, earthquakes, and cyclones are responsible each year for a large number of deaths and injuries. Over recent years, the emphasis in disaster management has shifted from post-disaster improvisation to pre-disaster planning. There is a strong feeling that one should be able to prevent or mitigate the human consequences through improved preparedness. The decade 1990-99 has been proclaimed by the United Nations the International Decade for Natural Disaster Reduction (IDNDR). Epidemiology is proving an essential tool to study the health effects of disasters and to suggest appropriate control measures at each of the phases of the disaster process, from prevention to long-term rehabilitation. Case-studies have shown that rescue by the disaster-struck community is the most effective way to reduce the death toll due to earthquakes. Disaster preparedness should be part and parcel of primary health care in disaster-prone areas. Appropriate information to evaluate needs should be preferred to precipitate relief. Epidemiological surveillance should replace indiscriminate vaccination. In the long term, disaster preparedness can provide a stimulus for setting up more efficient health services.

Accident Prevention↗
PubMedDate not supplied

After the storm: experiences and insights from the front.

You can never totally prepare for a disaster. However, from each occurrence we learn new lessons and gain insight to the preparations, collaborative strategies and flexible tactics needed to respond effectively. The scenarios below are a small sampling of what ACHE affiliates dealt with in the wake of Hurricanes Katrina and Rita. The leaders of these healthcare organizations know the importance of having a comprehensive disaster plan, adapting to the situation you face and stepping back to evaluate and make adjustments for the future.

Cooperative Behavior↗
PubMed1995

Lessons learned from Hurricane Andrew: recommendations for care of the elderly in long-term care facilities.

We report on the experience of a 500-bed, long-term care facility in Miami, Fla, which provides housing and nursing care units for patients--ranging from those who are independently ambulatory to those who are acutely ill and feeble--in preparing for, during, and in the immediate aftermath of Hurricane Andrew, which struck on August 24, 1992. The problems encountered included a massive influx of evacuated elderly to the facility, facility isolation, loss of electrical power, loss of running water, special dietary needs, and limited professional staffing due to personal property losses or loss of transportation. Overwhelmed county emergency medical services, limited access to hospitals and patient care, and difficulty in procuring supplies exacerbated the already complicated situation resulting from the storm. As a result of these catastrophic conditions, a number of challenges specific to the care of the elderly were identified. In conjunction with the Florida Department of Elder Affairs, we drafted a comprehensive blueprint that could serve as a disaster plan for other long-term care facilities facing a similar threat during the hurricane season.

Aged↗
PubMed1999

Oklahoma City's killer tornadoes: how local hospitals responded to yet another extreme disaster.

On the evening of May 3rd, a group of high-powered tornadoes tore through Oklahoma--leaving more than 40 people dead and hundreds injured. The main twister formed about 45 miles south of Oklahoma City and was classified F5, the most severe type of tornado, with winds of more than 260 mph. It cut a path one mile wide; stayed on the ground for more than four hours; and, along with other twisters, demolished 60 miles of countryside. More than 7,000 homes were destroyed or damaged, and more than 5,000 families were left homeless. Oklahoma City was hit the hardest, with about 1,500 homes leveled in the storm. A total of 755 people were injured in Oklahoma City and the surrounding area, testing local hospital disaster plans to the maximum. The same hospitals had been called on in April 1995 to handle the over 500 persons injured in the bombing of the Alfred P. Murrah Federal Building, a terrorist blast that killed 168. The hospitals' latest response to a disaster situation is recorded in this report.

Communication↗